Provider Demographics
NPI:1962027326
Name:SHUMWAY, RANDAL JORDAN (DO)
Entity type:Individual
Prefix:
First Name:RANDAL
Middle Name:JORDAN
Last Name:SHUMWAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 S MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-4400
Mailing Address - Country:US
Mailing Address - Phone:928-536-7519
Mailing Address - Fax:928-532-2139
Practice Address - Street 1:590 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-4400
Practice Address - Country:US
Practice Address - Phone:928-536-7519
Practice Address - Fax:928-532-2139
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ009441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine